Can’t wait to go to the symposium and to meet J-Lu!
Tissue sent the second time was not sufficient, either. There will be NO third try. Goobs is at the clinic, turned out in 1/2 acre field with run in shed and a neighbor next door. He wanted to come home this morning 
but at least he has a good setup over there.
Goober has a staph infection. Vet waiting for additional info as to the type of staph.
Not thrilled with vet OR with U Georgia… Upset and pissed
OMG LH I’d be PISSED!!!
:eek::eek::eek::eek: Sooo sorry to hear this!
I’m pissed and I don’t even know LH or Goober IRL!!! I can’t even comprehend the anger and despair she must be feeling. I wonder if his wound needs to be debrided or something. Systemic antibiotics don’t seem to be doing much good. What a shitshow. I’m sorry, LH. 
‘shit show’ sums it up.
Q for you, Libby ---- has your horse’s suspensory disintegration/tear begun to fill in with scar tissue? Goober’s has and the area of the tear is getting more and more opaque on each sonogram.
I have so many questions to ask the people from Georgia at the symposium tomorrow night, that I could take up the whole Q&A time.
Oh boy, I wish I could be there. I’m hoping that you and J-Lu will report back anything of interest! It’s too bad it wasn’t last Wednesday when I was down there for the MRI!
To answer your question, I have no idea what his suspensories look like as we haven’t done any follow-up ultrasounds. It became clear in January that the left front was his limiting issue so we have been focusing on that. To be honest I don’t have a clear idea of what they were like before the probably-pointless neurectomy either. The vet’s report is pretty bland: “mild irregularity in the fiber patterns and a mild irregular surface to the plantar third metatarsal bone.” He never had a “tear,” just that mild irregularity. My theory now is that it’s from compensating for the injury to the LF. I wish I had done the MRI of the front feet back in November…I might have a sound horse by now, who knows.
I guess there’s no point in regrets though. The plan going forward is to do three sessions of shockwave and then go back for a check-up (not with the vet who did the probably-pointless surgery). There’s no way to see the collateral ligament injury without an MRI but at least we can see how the lameness is progressing, or not, and we will also work up the left hind. Since he had the neurectomy, his 2/5 LH lameness should not be coming from the proximal suspensory anymore so the question is, what is causing that now? If we do an ultrasound then I’ll share anything of interest.
Speaking of shockwave, I am having a hard time trusting vets after this neurectomy mess and I can’t find any evidence that shockwave actually helps collateral ligament injuries. This study found it made no difference: https://www.ncbi.nlm.nih.gov/pubmed/20095228. There are a lot of positive anecdotes out there about shockwave in general but how do those people know the horse wouldn’t have healed just as well with the same period of rest and no shockwave? It’s frustrating. I’m inclined to do it because rest alone hasn’t helped him (though for most of that time he has been on turnout and now he’s on stall rest) but it’s not cheap and I hate the thought that I might be paying for voodoo…
We did shock wave treatments for my horse, medial collateral and distal sesamoid impar ligament injury , and tear on DDFT at P2 and navicular. We did some other stuff too so I can’t tell you if the shock wave specifically helped but I’m glad I did it. He was given a 35% chance of being riding sound again and we made it… hang in! And sometimes you really need a little voodoo…especially when dealing with horses.
@Libby2563 my friend’s horse had a collateral ligament issue several years ago now. They wound up doing stem cell injections after a period of rest did nothing–I think a total of 6 done over 2 or 3 rounds. Pretty new thing at the time. Horse’s lameness went away, but a hole had still been visible on Xray at the bone attachment. Wound up going in for an MRI and found the ligament had reattached elsewhere. Horse is still doing low level work (now somewhat limited by OCDs elsewhere), although the owner retired him from jumping.
I have found shockwave to help certain things. Local pain as well as bursitis and some associated ligament inflammation. I have a few vets that love shockwave for a lot of things. But for fiber disruption or tears in tendons or ligaments, they are now going with more of the biologics–PRP, IRAP, stem cells.
I’ve heard stem cells not shockwave for collateral ligament injury?! PRP as second best after stem cells?!
all this is a fair amount of voodoo/guesswork if we’re being honest
Ain’t that the truth!? It can get so frustrating.
Maybe it depends on how bad the injury is? Jungle Monkey’s horse’s injury sounds a lot worse than mine, which is “moderate desmopathy.” Also I think the vet is being conscious of the fact that my horse has other possible career-limiting issues and isn’t insured (have I mentioned how much I’m regretting that decision?) so I may not want to pour insane amounts of money at this one issue. We talked about IRAP for the coffin joint and he said it’s too expensive for him to recommend right now (paraphrasing).
In any case, my regular vet came and did the first shockwave treatment this morning. I’m just going to go with it. I’m much more at peace now that we have a diagnosis and a plan.
In that spirit, I’m trying not to second-guess that the lameness vet hasn’t prescribed any handwalking. In reading about ligament rehab, controlled exercise seems pretty important. Maybe he wants to wait on that until we see a little progress? I don’t know. Relying on vets is what got me into the neurectomy mess but I can’t be my own vet either so 
.
IRAP more expensive than shockwave? Is your vet cheap for shockwave? Series of 3 IRAP injections runs what, like $700? I can easily run up a bill higher than that with shockwave, which is also recommended in a series.
Stem cells are very expensive, but if you are lucky, you can get a lot of injections out of them. I got 80,000 cells grown from a sample of bone marrow. I used 50,000 (10,000 per injection, did 3 injections first round then 2). I have 30,000 sitting in a freezer for a relatively low annual fee–I’d have to bank them for many, many years before it would be more cost effective to start over.
In any event, I don’t think shockwave is really the “standard” anymore for the kind of injury you’re facing. Most will go with the biologics, especially considering shockwave is also crazy expensive. One of my vets really likes shockwaving things. But even he said I should do PRP, IRAP, and stem cells for my horse’s DDFT injury. He said if I didn’t want to pay for stem cells (did not have enough insurance coverage for that, what with everything else we had going on that year), he said at least do PRP and IRAP to get the inflammation down. Based on location of the fiber disruption and a second opinion, I decided to go with the stem cells. Seemed to work great! Would he have healed as well without them? Who knows, maybe.
and isn’t insured (have I mentioned how much I’m regretting that decision?)
To be honest, if your your insurance is like ours here, its probably not as big to regret as you might think.
I steamed through my medical insurance cap really quickly, in very modest diagnostics (a missed chance to diagnose meant nearly all diagnostics were repeated, and hospital stays at 250 a night) and 2 fairly simple surgeries. They wanted to MRI his head and decided againt it, luckily.
Also because my insurance renewal was due 6 months after the surgery, it already had millions of exclusions, and they used my claims to tell me that my mortality cover was far too high now. 12mo seems like a long time, but it really isnt in these situations, he should have been covered 12 months from the last surgery, before they ruled it as a new injury (and excluded by the exclusions). At the point I wanted to Euth him, they wouldnt allow me too and claim my cover.
Although im really grateful I had it, as I really couldnt afford the surgeries, and it was great to be reimbursed, ive dropped insurance on him after speaking to the underwriter who warned me about what he would be covered for in future - basically nothing and no value under mortality.
This thread is really depressing I must say, I wonder time and time again when seeing these sorts of issues why we try and ride horses when they are clearly so fragile. I think I will go cry in a corner!
OP I hope you get some good outcomes, certainly you can never feel that you didnt give it your absolute all.
From notes that J-Lu took last night at the DSLD symposium, the diagnostic test they are doing at U Georgia is not worth it. They will not stand behind the results, which are merely ‘suggestive’ and are not meant to be promoted as ‘diagnostic’ (at least that is what I got from it — I am sure that J-Lu will confirm or correct me.
Sorry I know just how you feel! I keep telling DH that I never want another horse after this mess. He thinks I would be lost without horses but I don’t know, it’s so much stress and heartbreak. I also hate how I have to depend on other people’s competence to keep my horses healthy (vets and farriers).
I will say that I was looking at my 23-year-old horse’s vet records this weekend and he’s proof that while they are fragile, they can overcome a lot too. All before age 10 he had loose stifles, hind suspensory desmitis, EPM, an annular ligament injury, a torn DDFT, a penetrating injury to the coffin joint, and a bone cyst in his shoulder that ended up requiring three surgeries. Believe it or not he recovered from all that and we did our first Grand Prix dressage test when he was 17. He gives me hope for my young man…
For the collateral ligament injury, ask your vet and farrier if there are some shoeing changes they can make - I think clogs or a rocker shoe (?) to reduce leverage on the soft tissues.
I passed on shockwave for a collateral ligament injury of the fetlock that was probably lingering/chronic. He had cellulitis in that leg earlier in the year and the whole leg was enlarged after. When the fetlock didn’t go back to normal, I didn’t think it was anything new. Then he likely twisted his ankle in the pasture months later and the unsoundness was much more consistent and the fetlock got bigger.
My vet did some research and asked the shockwave distributor about using it for a chronic injury and we decided that the evidence showed more success with acute injuries and there’s really nothing to show shockwave would work for a chronic injury. We did end up doing Osphos 3 months into stall rest after a radiograph showed some possible bone remodeling at the insertion of the ligament in the pastern.
Hmm, I thought the vet said that IRAP was more like $1,000+ for the series. I haven’t gotten my first bill for the shockwave yet so we will see I guess. (By the way, the vet who recommended shockwave isn’t the one performing it because I didn’t want to take a whole day off work to ship to him every time, so he’s not gaining anything from it financially.) I thought IRAP was more for joints but it seems I might be behind the times on that.
This is stressing me out all over again. Four vets have now done lameness evals on this horse and I don’t think I have the money or energy to seek more second opinions on the treatment now that we finally have a diagnosis (I wasn’t trying to vet shop FWIW…twice my first choice of vet was unavailable so I saw someone else and then they became available so I saw them too). Now that I have chosen a vet (very well-respected and highly-credentialed) I feel like I should respect his recommendations rather than playing vet on the internet. Ugh.
Thanks, he just got a special shoe put on Tuesday on the vet’s recommendation. It’s basically a homemade version of this in steel rather than aluminum: http://www.grandcircuitinc.com/products/denoix-collateral-front-shoe
Interesting about the chronic vs. acute injury. Do you think the Osphos helped?
I hope the shoe helps! It looks like you are on the right track with everything. I can’t remember if your MRI diagnosis included any bony changes and if you aren’t sure, it wouldn’t hurt to ask the radiologist who read the MRI.
I think the Osphos helped because 3 months after the injection he was sound and we started rehab. The ligament never had a hole, it was just enlarged, so I suspect some of the pain was coming from the bone remodeling. I also agreed to the Osphos because my horse has arthritis in other joints and we figured it would help with that as well. His hocks flexed really well compared to his baseline after the rehab.
My vet said even if I did shockwave - he was going to predict 3-6 months of stall rest. I don’t regret deciding not to do the shockwave and just prepared myself for an 8+ month recovery. My horse was on stall rest from Dec 1-April 1 and we started handwalking. I started riding him for rehab and he went outside in a very small pen in early May . By July 1, he was was trotting for 20 min and cantering for 20 min on big circles and went back into full turnout.
I’m using those too
Warning, LONG post! I thought this was an appropriate place to put it. I attended a mini-symposium at NC State last night that was on DSLD and featured the Chief Medical Officer and Director of Equine Programs at Univ of GA (Dr. Mueller), and Pathology professor and MD, Dr. Halper. She is the one who discovered that DSLD horses have increased proteoglycans in their tendons and developed the staining technique that uncovers this. She is an expert in tendons and ligaments, not horses. Please let me know if you have any questions, this is an abbreviated summary:
DSLD notes!
From NC State Symposium with Dr. Halper (MD, Ph.D., pathologist) and Dr. Mueller (DVM, Ph.D – equine surgeon)
Dr. Mueller :
He said the onset of DSLD is usually from foals to 5-6 years of age, although it can show up in older horses. The biggest differential diagnosis is traumatic injury or desmitis from regular work. He sees subclinical desmitis all the time in sport horses, and he usually sees a mix of signs of desmitis and DSLD when looking at DSLD horses in work.
He believes ultrasound can often be a useful diagnostic because DSLD presents WITHOUT core lesions or acute inflammation because it is chronic. (showed ultrasounds) The ligaments are enlarged, but not very painful because the ligaments have more ground substance/proteoglycans between the fibers that have built up over time. As horses age, they accumulate more proteoglycans and therefore age is important in the reading of any histological tests.
He stressed that the nuchal ligament staining is not a perfect correlation. NOT a perfect correlation. It does not correlate with extent of disease. It’s subjective. NOT ALL, but most horses with significant proteoglycan accumulation can develop the syndrome. It’s the most predictive, least invasive ligament to biopsy in working horses that they have come up with.
Veterinarians often get the wrong tissue on biopsy, and often go too high in the crest. Vets use needle biopsies, core biopsies, and other insufficient techniques. He makes a vertical cut, about 2-3 inches, then dissects down to the ligament and visualizes it. He uses Kelley hemostats to isolate about an inch of ligament, then cuts dorsal and caudal to that, so the ligament is attached to the forceps. He then closes the would and gives one shot of penicillin. His incisions close nicely, and he always makes them on the side the mane falls on so any scar will be covered. His scars heal well. He is a surgeon… He is happy to talk to vets prior to biopsy about technique.
Major decisions, such as euthanasia or breeding, CANNOT- be made on biopsy results, he stressed. The whole horse presentation must be used in evaluating the condition. It is not a condition of the suspensory ligaments, it affects the whole horse. It is likely a syndrome.
There’s no treatment for the condition. Shock wave therapy, stem cell therapy won’t work. The degeneration will continue. He knows an ambiguous result is very hard on clients and talks to them regularly. Shoeing changes can make a horse more comfortable, and he showed shoes that can keep a fetlock from rubbing the ground (<shudder>).
An NC State vet said he is seeing a sharp increase in Warmbloods but doesn’t know why.
Dr. Halper talked about the study and histology techniques she uses to identify what is probably a defect in an enzyme that regulates proteoglycans.
She said horses have more collagen in their arteries than humans. The DSLD horses had definite changes in cardiomyocytes, aortic smooth muscle and other cells – the effect is unknown. Friesians can exhibit cardiovascular mortality with DSLD, but they only have anecdotal evidence as the only horses they’ve seen this happen in are Fresians. Low n size.
She has done some genetic work (next generation sequencing) to look at upregulation/downregulation of genes with DSLD, but it is expensive and hard to get tissue from horses (she uses a skin biopsy, but funding is a real issue to continue the work). Plus, I know that the published genetic sequence is from one breed (don’t know what it is) and there’s a TON of variability in horse breeds. What are normal splice variants or expression of any equine gene? She is trying to get funding from horse-specific sources, too.
I talked to them both individually for some time, and they are both very cognizant of how difficult it is for owners to get only a probability from the nuchal ligament result. But since they have seen false positives, they DO NOT want an owner to give up on their horse if the test is the ONLY piece of data. Again, they stressed that the vet’s responsibility is to look at the whole horse, and Dr. Mueller indicated that sometimes, the vet has no idea and throws out the biopsy idea.
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